Quality and price of dentists in the north compared to the south

willmunny1990

I always find dentists from the Republic of Ireland attempt to justify their obscene prices with 'we have better quality'.

I was talking to a dentist from the North recently and he insisted that the quality of materials used up there is as good, if not better that the materials used in the South, but there remains a huge gap in pricing.

How long more will dentists in the South get away with this carry on?

res ipsa

good man will, fair play teh ye!:D

im invisible

I lived and worked in the uk for a year, got a tooth pulled for 15 quid, would have cost over 100 euro at home,,,

btkm8unsl0w5r4

This guy is not so cheap http://www.basilmizrahi.co.uk/fees.htm

I think you will find that quality and cost varies in every country in a inverse relationship. You will get what you pay for I am afraid. Those who provide low quality will assure you it is all you require. Those that provide high quality will say nothing as their work speaks for itself. There are a few that provide low quality at high cost but they dont last long.

I love when people going on about the materials being the same, thats not the point. I can use the same paints as picasso, however my paintings will be crap.

davo10

im invisible wrote: »

I lived and worked in the uk for a year, got a tooth pulled for 15 quid, would have cost over 100 euro at home,,,

This would have been done in an NHS dental clinic, not a private one. The nearest scheme we have here to the NHS dental scheme is/was the Medical Card scheme, you can get a tooth pulled for free under this scheme and the last time I checked free was cheaper than £15. If you had gone to a private clinic it would be considerably more than £15 for an extraction in the UK.

Just a little extra info because I worked in an a practice in the North for a time albeit over 10 years ago.

1. Every clinic in the North who saw NHS was entitled to a grant for clinic improvement, this could be up to £50,000. I sure would like to have got that here.

2. There was a scheme called "capitation and continuing care" where the UK Government paid a dentist between £1.50 and £3 every month for every NHS patient regeistered at their clinic for the 13 months after each check up. The different payments depended on the age of the patient and was made REGARDLESS of wheather any treatment was carried out. Now the clinic where I worked had over 10,000 registered patients so the owner was payed approx £20,000 per month before he was paid for all the treatments we carried out on the patients. This scheme I believe has since been revised but I can tell you that here we get paid for the work we do, not just for having a certain number of patients registered at our clinic. I can assure you if I was recieving those payments I could afford to charge patients less.

3. On the NHS we used to get paid £120 for an anterior crown so the boss had to find a Lab who would make one for £40, oh man were they s**t, and we were allowed to book off 30 mins for a crown prep. Now I book off 105mins for a single tooth crown and pay a great lab top price for their incredible ceramic crowns.

4. If you check the websites of clinics in the South and compare them with the websites of our colleagues in the North you will see very little difference in price, but there will always be bargain basement providers both up there and down here. As Fitz said, most often in life you get what you pay for.

5. You guys should consider what part you play in all this hypocracy. Your wages and benefits are still higher than in most other EU countries including the UK. So if you want cheaper goods and services, do not complain if your wages/benefits/minimum wage rates are cut.

6. Why is it that we pretty much (for now) get free domestic water but in the UK they have been metered for decades, why do we only have to pay a registration fee to go to College but in the UK students have to pay £9,000 every year, etc, etc, etc the grass is not always greener over there.

AnonDentist

Great points Davo10

Oral Surgeon

http://www.youtube.com/watch?v=S8zGB7vFNRI

This guy explains the difference between expensive dentist and cheap dentist really well....

yobr

Marjorie Ugly Musket wrote: »

You will get what you pay for I am afraid. Those who provide low quality will assure you it is all you require. Those that provide high quality will say nothing as their work speaks for itself. There are a few that provide low quality at high cost but they dont last long.

davo10 wrote: »

If you check the websites of clinics in the South and compare them with the websites of our colleagues in the North you will see very little difference in price, but there will always be bargain basement providers both up there and down here. As Fitz said, most often in life you get what you pay for.

While we are now getting cheaper prices for dental services, it must be remembered that the Competition Authority in their last major examination of the dental sector in Ireland (2007) found that "The price of private dental treatments has consistently increased above the general rate of inflation and above the rate of health inflation. Between 1990 and 2007, the Consumer Price Index (CPI) increased by 69%, health costs grew by 147% while dental services increased by 171%, according to data from the Central Statistics
Office (CSO)"

At that point, Irish patients were definitely paying more for their services than they should have been...There are definitely cases where people availing of dental tourism in certain countries are getting too much treatment and some of it is of inferior quality although given the information quoted in the CA report, you can see why this dental tourism has been popular.

http://www.tca.ie/EN/News--Publications/News-Releases/Competition-Authority-finds-a-lack-of-competition-in-dental-services-is-pushing-up-prices-in-Ireland.aspx?page=1&year=2007

Big_G

I know several dentists in the north that I respect highly and all of them charged more for their services than I was getting for fees in the south when I worked there. Might I suggest that the CA report did not include fees that dentists were getting for medical card treatments for which increases were lower than inflation since 1991. Some dentists who were making very little profit from the medical card scheme were supplementing their medical card income with an increase in private fees, although that wouldn't account for all of that 171%. Some dentists were significantly dependant on medical card income and are now suffering because of that.

What else could account for an increase in fees? Well let's go back to economics 101. Could an increase in demand cause in increase in cost? Hmmmm...... All the dentists I know will only increase fees if they are too busy to cope with the demand.

yobr

Big_G wrote: »

Might I suggest that the CA report did not include fees that dentists were getting for medical card treatments for which increases were lower than inflation since 1991. Some dentists who were making very little profit from the medical card scheme were supplementing their medical card income with an increase in private fees, although that wouldn't account for all of that 171%.

What we are talking about here and the CA report is private dental fees.

The fees for medical card holders have their own seperate fee negotiation system...it was open to dentists to leave that system,or throught the IDA renegotiate their fees...indeed from figures available some dentists did extremely well from the medical card scheme which was not always policed as it should have been...

Oral Surgeon

yobr wrote: »

What we are talking about here and the CA report is private dental fees.

The fees for medical card holders have their own seperate fee negotiation system...it was open to dentists to leave that system,or throught the IDA renegotiate their fees...indeed from figures available some dentists did extremely well from the medical card scheme which was not always policed as it should have been...

I have never been involved with the medical card scheme but when you say that some dentists did extremely well from the scheme, what exactly do you mean? Have you seen their accounts? Don't make the rookie mistake of mixing up gross and net profits. I have seen the fee per item on the MC and in order to make 100k or 200k that you may quote- there needs to be a crapload of work by in many cases more than one dentist, multiple nurses, admin staff and all the other expenses that PAYE workers would not understand.... The actual take home less these expenses and taxes is not so impressive.

OS

davo10

yobr wrote: »

What we are talking about here and the CA report is private dental fees.

The fees for medical card holders have their own seperate fee negotiation system...it was open to dentists to leave that system,or throught the IDA renegotiate their fees...

Exactly, and we did, which is why the market did and continues to set the price, if you feel they are too high then it is your right not to pay them, but the price gap has reduced due to market forces. Open market at its best.

Incidently, when Dermot Jewell was asked about this report and the cost of MC fees, he said he did not have any data about MC fees and the effect of providing "below cost dental treatment". Furthermore when asked about the price questionaire, he admitted that the scope did not take into question the type of filling, type of crown, type of bridge etc. For instance a "bridge" could be a Maryland bridge which is at the lower end of the fee scale of a Lava bridge which is at the higher. The most recent price comparison compared clinics in Blackrock, Eyre Square Galway and O'Connell St limerick witha clinic in Banbridge a tiny village which even by Northen standards was cheap. That is either lazy or inept investigative work, but it makes good copy. Go figure.

Yobr with an open market you can travel anywhere you want for treatment, we know that and our patients know that so what is the problem?, we live in an age where prices of everything can be checked on a computer but this cannot gaurantee quality, and that goes for both treatments in North and South.

Regarding the clinics doing well from Med card scheme, the clinic owner is the registered payee but there are many assocites working there so that is devided many times. Take a clinic where an assocaite grosses €100,000. The owner gets half out of which he/she pays a nurse (say €25,000) and equipment Lease (€5,000), all matarials fees plus half laboratory costs (€10,000) then 40% tax on net amount = f**k all.
The associate gets €50,000 less half lab fees (€5,000) less indemnity insurance, registration fees, less tax etc. Hardly a mountain of cash is it?.
Many clinics are letting their assocites go and that again applies both North and South. That's life.

yobr

Oral Surgeon wrote: »

when you say that some dentists did extremely well from the scheme, what exactly do you mean?

This thread is not about the medical card scheme and I don't want to drag it off topic, however, as you asked. I am talking about two things (i) the actual fees that some dentists have received, these are regularly printed in newspapers, and (ii) the levels of fraud in the medical card system.

The report below is interesting reading.
http://www.lenus.ie/hse/bitstream/10147/85398/1/probity_assurance_report.pdf

At one point, the author, who had previously worked with the HSE on this issues states "It is difficult to assess the amount at risk in such circumstances but work in England and Wales suggests that, after
operating a probity system for many years the raw risk (that is, before checks) of inappropriate payments being made is at least 8 per cent of the total expenditure.

In a system with few if any checks such as that operated by the HSE, and boosted by apparent changes in the attitude of the authorities to such issues, a much higher rate, probably in excess of ten per cent would be expected."

Given that PCRS paid out more than €250m to dentists in this scheme over the last five year, this amount at risk is not inconsiderable.

Finally, I want to be clear that I not alleging that any dentists on this site were/are involved in any financial inappropraite behaviour regarding this scheme. All I am doing is setting out certain facts which are in the public domain regarding the medical card scheme.

Big_G

We are indeed getting into dangerous territory here yobr, there was probity in the guise of the Examining Dentist Scheme, which was scrapped due to the lack of abuses being found. It was not a cost effective probity scheme because it was not finding any abuses.

Probity is written into the contract that you sign when you join the DTSS.

To suggest that 8% equates to abuse is a) nonsense as clerical error can be that high, which you would know if you dealt with the HSE on a daily basis and b) tarring the whole of dentistry with the same brush. Admittedly there may be some dentists who abuse the system either by increasing the volume of work, using cheaper foreign labs, decreasing the quality of their work or even by so called 'paper' dentistry, these guys are in the minority. The fact of the matter is a significant proportion of the medical card work is and was done at below cost.

The CA report findings have been roundly accepted for the most part. However, I would dispute some of the figures being bandied about because they don't include the medical card scheme which was supposedly negotiated in a free market environment which is nonsense. The government was holding on to a large chunk of the market and drove the price of treatment down significantly which is anti competitive in my eyes. The Competition Authority seems to agree as it won't allow the IDA to negotiate on behalf of the profession for a new scheme. It's all moot now anyway because the government hasn't the money to pay for a dental scheme.

I think you'll find that the dataset and landscape has significantly changed since the publication of the report and will further change with the new Dentist Act due to be published soon.

It's simply a waste of energy to discuss what was going on 2-3 years ago because things have changed so much. In fact large chunks of that report are now useless, particularly with regard to training dentists and specialists. Not one graduate from DDH this year took up a job in private practice in Ireland AFAIK. Some took VT, for which there will be no private job forthcoming, some took hospital jobs to start specialist training pathways and about 75% emigrated straight away after graduation. So why is the government even paying to train them? I suggest that the CA report is significantly outdated in this respect. I suspect a lot of dentists who thought they would be retiring in the next year or two will not now do so either.

btkm8unsl0w5r4

Why are we giving so much attention to a deeply flawed report in 2007 using data older than that again....it bears no relation to dental competition in 2011. I hear houses in Ireland were pricey then too

We now have a competitive landscape where you can basically find a place with the price you want to pay (whether it a good idea is tender irreversible skilled healthcare to the lowest bidder is another debate). However my issue in this forum it that while cynics like to have the price of everything and the value of nothing, whats far more important than price is value. Value is a combination of price, service and quality. The consumer can appreciate this difference in quality and price in every other product from Premium cars to Tesco Finest. But for some reason it comes as a revelation in healthcare.

Not all Dentists are equal, not all dental work is equal. Not all prices are the same. You will get what you pay for. Often the cheapest dental work is the most expensive.

davo10

yobr wrote: »

This thread is not about the medical card scheme and I don't want to drag it off topic, however, as you asked. I am talking about two things (i) the actual fees that some dentists have received, these are regularly printed in newspapers, and (ii) the levels of fraud in the medical card system.

The report below is interesting reading.
http://www.lenus.ie/hse/bitstream/10147/85398/1/probity_assurance_report.pdf

At one point, the author, who had previously worked with the HSE on this issues states "It is difficult to assess the amount at risk in such circumstances but work in England and Wales suggests that, after
operating a probity system for many years the raw risk (that is, before checks) of inappropriate payments being made is at least 8 per cent of the total expenditure.

In a system with few if any checks such as that operated by the HSE, and boosted by apparent changes in the attitude of the authorities to such issues, a much higher rate, probably in excess of ten per cent would be expected."

Given that PCRS paid out more than €250m to dentists in this scheme over the last five year, this amount at risk is not inconsiderable.

Finally, I want to be clear that I not alleging that any dentists on this site were/are involved in any financial inappropraite behaviour regarding this scheme. All I am doing is setting out certain facts which are in the public domain regarding the medical card scheme.

I read this post earlier and found it very interesting. I have not worked in the Med card scheme for years so I am not familiar with it's workings over the last decade but as coincidence would have it I've just come back from lunch with the local HSE dental pricipal who is a friend. I asked him about this post and he told me that he was involved in the probity (Examining Dentaist) scheme and its report undertaken by the HSE a few years ago.

Appearently the initial report was written by a UK analytical consultant called Paul Bachelor. He took data from the NHS ( Yobo see the reference to "work in England and wales suggests that" )dental programme, extrapalated the results and applied it to the Irish Med Card Scheme. The HSE wanted to check probity, ensure governance and patient safety so they employed 22 external independent dentists to check thousands of patients, from every dentist participating in the scheme for accuracy in treatment approval, accuracy of treatments claimed for payment and quality of treatment.

He said it was a collossal waste of money and cost the HSE millions, they found virtually nothing and Yobo, get this, to his knowledge only one dentist ended up in front of the Dental Council and he was a guy from the North who's main practice was in the North and who also had a clinic in the South. He blamed his nurse for filling out the med card payment forms incorrectly. Ironic in a way.

yobr

Big_G wrote: »

We are indeed getting into dangerous territory here yobr,

The CA report findings have been roundly accepted for the most part. However, I would dispute some of the figures being bandied about because they don't include the medical card scheme which was supposedly negotiated in a free market environment which is nonsense. The government was holding on to a large chunk of the market and drove the price of treatment down significantly which is anti competitive in my eyes. The Competition Authority seems to agree as it won't allow the IDA to negotiate on behalf of the profession for a new scheme. It's all moot now anyway because the government hasn't the money to pay for a dental scheme.

I think you'll find that the dataset and landscape has significantly changed since the publication of the report and will further change with the new Dentist Act due to be published soon.

It's simply a waste of energy to discuss what was going on 2-3 years ago because things have changed so much. I suspect a lot of dentists who thought they would be retiring in the next year or two will not now do so either.

Big G,

I quoted the CA report, which I agree was agreed by most and is now outdated, to illustrate the fact that prices for dental services here were uncompetitive in the past. I agree that this situation has improved for the Irish patient. I agree that dentists may not retire as they thought they might but that is a common occurrance across the Irish economy.

yobr

Marjorie Ugly Musket wrote: »

Why are we giving so much attention to a deeply flawed report in 2007 using data older than that again....it bears no relation to dental competition in 2011. I hear houses in Ireland were pricey then too

I have replied to this point in my previous post........

yobr

davo10 wrote: »

Appearently the initial report was written by a UK analytical consultant called Paul Bachelor. He took data from the NHS ( Yobo see the reference to "work in England and wales suggests that" )dental programme, extrapalated the results and applied it to the Irish Med Card Scheme.

It is a little unfair to describe Dr. Batchelor as a mere "analytical consultant" as his cv demonstrates.... He is a qualified dentist and worked in practise...Also, as his report informs he has done previous work with the HSE on probity so would, I assume, be well versed on the DTSS and the HSE systems, and in this regard, his comments regarding probity would be fairly accurate.

As his cv informs, he is also advised the Parliamentary Health Committee on their inquiry into NHS Dentistry under the new GDS and PDS contracts.

http://www.oralcareconsulting.com/about-us/the-directors/paul-batchelor

Oral Surgeon

yobr wrote: »

It is a little unfair to describe Dr. Batchelor as a mere "analytical consultant" as his cv demonstrates.... He is a qualified dentist and worked in practise...Also, as his report informs he has done previous work with the HSE on probity so would, I assume, be well versed on the DTSS and the HSE systems, and in this regard, his comments regarding probity would be fairly accurate.

As his cv informs, he is also advised the Parliamentary Health Committee on their inquiry into NHS Dentistry under the new GDS and PDS contracts.

http://www.oralcareconsulting.com/about-us/the-directors/paul-batchelor

What prompts this search for the truth??

btkm8unsl0w5r4

Oh Jesus now were discussing the medical card dental scheme that no longer exists in any meaningful way. What is the point of this now.

Oral Surgeon

Oral Surgeon wrote: »

What prompts this search for the truth??

I retract that question- I don't care....

yobr

Marjorie Ugly Musket wrote: »

What is the point of this now.

yobr wrote: »

I quoted the CA report, which I agree was agreed by most and is now outdated, to illustrate the fact that prices for dental services here were uncompetitive in the past. I agree that this situation has improved for the Irish patient.

Good night gents.

res ipsa

yobr wrote: »

Marjorie Ugly Musket wrote: »

You will get what you pay for I am afraid. Those who provide low quality will assure you it is all you require. Those that provide high quality will say nothing as their work speaks for itself. There are a few that provide low quality at high cost but they dont last long.

davo10 wrote: »

If you check the websites of clinics in the South and compare them with the websites of our colleagues in the North you will see very little difference in price, but there will always be bargain basement providers both up there and down here. As Fitz said, most often in life you get what you pay for.

While we are now getting cheaper prices for dental services, it must be remembered that the Competition Authority in their last major examination of the dental sector in Ireland (2007) found that "The price of private dental treatments has consistently increased above the general rate of inflation and above the rate of health inflation. Between 1990 and 2007, the Consumer Price Index (CPI) increased by 69%, health costs grew by 147% while dental services increased by 171%, according to data from the Central Statistics
Office (CSO)"

At that point, Irish patients were definitely paying more for their services than they should have been...There are definitely cases where people availing of dental tourism in certain countries are getting too much treatment and some of it is of inferior quality although given the information quoted in the CA report, you can see why this dental tourism has been popular.

http://www.tca.ie/EN/News--Publications/News-Releases/Competition-Authority-finds-a-lack-of-competition-in-dental-services-is-pushing-up-prices-in-Ireland.aspx?page=1&year=2007

Dental costs went up 171% the idiot competition authority should have been looking at housing costs a 400% increase all on borrowed money & one that will bankrupt my generation of paddy's & Bridget's

yobr

res ipsa wrote: »

Dental costs went up 171% the idiot competition authority should have been looking at housing costs a 400% increase all on borrowed money & one that will bankrupt my generation of paddy's & Bridget's

Someone else who obviously didn't like what the CA report stated.

btkm8unsl0w5r4

I dont think people really care what a out of date 5 year old report says at this stage.

kadman

So should i be going north, or staying south for general fillings , extractions ect. In short, for normal dental interventions, whats the price comparison between the two for extractions and fillings.

The last dentist I visited, put me entirely off the process, painfully and its been a few years since I was at one. But now the need arises....arghhhh.;)

kadman

Big_G

I'm sorry but threads about relative price are not allowed on the forum. This is Dental Issues, not Consumer Issues or Bargain Alerts. This should have been closed ages ago.